Bidirectional Relationship between Gastric Emptying and Plasma Glucose Control in Normoglycemic Individuals and Diabetic Patients
Open accessAbstract
Gastric emptying and glycemic control pathways are closely interrelated processes. Gastric chyme is transferred into the duodenum with velocities depending on its solid or liquid state, as well as on its caloric and nutritional composition. Once nutrients enter the intestine, the secretion of incretins (hormonal products of intestinal cells) is stimulated. Among incretins, glucagon-like peptide-1 (GLP-1) has multiple glycemic-regulatory effects that include delayed gastric emptying, thus triggering a feedback loop lowering postprandial serum glucose levels. Glycemic values also influence gastric emptying; hyperglycemia slows it down, and hypoglycemia accelerates it, both limiting glycemic fluctuations. Disordered gastric emptying in diabetes mellitus is understood today as a complex pathophysiological condition, with both irreversible and reversible components and high intra- and interindividual variability of time span and clinical features. While limited delays may be useful for reducing postprandial hyperglycemias, severely hindered gastric emptying may be associated with higher glycemic variability and worsened long-term glycemic control. Therapeutic approaches for both gastric emptying and glycemic control include dietary modifications of meal structure or content and drugs acting as GLP-1 receptor agonists. In the foreseeable future, we will probably witness a wider range of dietary interventions and more incretin-based medications used for restoring both gastric emptying and glycemic levels to nearly physiological levels.
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These fluctuations lead to pronounced glycemic variability, and the altered rates of gastric emptying can hinder the ability to appropriately adjust prandial insulin doses to the actual amount of ingested nutrients.
“These fluctuations lead to pronounced glycemic variability, and the altered rates of gastric emptying can hinder the ability to appropriately adjust prandial insulin doses to the actual amount of ingested nutrients [96].”
From Diabetic gastroparesis: pathophysiology and impact on insulin timing choices (2026) · cites this paper as [96]
Section 5 says altered gastric-emptying rates may impair adjustment of prandial insulin to ingested nutrients in patients with type 1 diabetes. The Conclusion says fluctuations in gastric emptying strongly associate with variations in postprandial glucose, but it does not establish that fluctuations invariably lead to pronounced glycemic variability. The Abstract more narrowly says severely hindered emptying may be associated with higher glycemic variability. Page numbers were not available in our copy. (LLM, conf=0.86)
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“Recent experimental data attribute damage of myenteric cholinergic neurons and interstitial cells of Cajal to impaired signalling through the axes of insulin and insulin-like growth factor-1 receptors [32, 39].”
BackgroundDecreased Gastric Motility in Type II Diabetic Patients
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“Recent data also suggest a relation between glycemic values and stomach emptying [13, 23].”
BackgroundLipid droplet size and emulsification on postprandial glycemia, insulinemia and lipidemia
Tan, K. W. J., Sun, L., Goh, K. K. T., & Henry, C. J. (2016) · Food & Function · doi:10.1039/c6fo00897f · Cited by 21 · cited 1× · see citing works
“showed that fine emulsions of olive oil in water slowed gastric emptying more than a coarse emulsion or a nonemulsified mixture of olive oil and water [9].”
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Duodenal bulb control of the flow rate of digesta in the fasted and fed dog.
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BackgroundOkabe, T., Terashima, H., & Sakamoto, A. (2017) · Clinical Nutrition · doi:10.1016/j.clnu.2016.08.014 · Cited by 17 · see citing works
Albèr, A., Brønden, A., & Knop, F. K. (2017) · Diabetes Obesity and Metabolism · doi:10.1111/dom.12911 · Cited by 14 · cited 1× · see citing works
“Novel therapeutic guidelines for type 2 diabetes recommend the association of prandial GLP-1 receptor agonists to basal insulin; benefits of such pharmacologic combinations bring together the predominant effect of basal insulin on fasting glycemia and the effect of prandial GLP-1 receptor agonists on postprandial glyc…”
BackgroundAntecedent Hypoglycemia Does Not Attenuate the Acceleration of Gastric Emptying by Hypoglycemia
Kar, P., Jones, K. L., Plummer, M. P., Abdelhamid, Y. A., Giersch, E. J., Summers, M. J., Hatzinikolas, S., Heller, S. R., Horowitz, M., & Deane, A. M. (2017) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2017-00051 · Cited by 14 · cited 2× · see citing works
“Most authors found that gastric emptying is increased even after recurrent episodes of hypoglycemia, not only in healthy individuals [24] but also in diabetic patients [50].”
BackgroundMano, F., Ikeda, K., Joo, E., Yamane, S., Harada, N., & Inagaki, N. (2018) · Nutrition (Burbank, Los Angeles County, Calif.) · doi:10.1016/j.nut.2017.08.007 · Cited by 13 · cited 2× · see citing works
“However, paradoxical results are also published, leaving the debate about free amino acid effects on gastric emptying still open [71, 72].”
BackgroundHammersjö, R., Roth, B., Höglund, P., & Ohlsson, B. (2016) · The Review of Diabetic Studies · doi:10.1900/rds.2016.13.79 · Cited by 13 · cited 2× · see citing works
“Several research teams found a direct relationship between the rate of gastric emptying and postprandial serum glucose levels [6, 7, 48, 49].”
BackgroundLee, A. A., & Hasler, W. L. (2017) · Current Treatment Options in Gastroenterology · doi:10.1007/s11938-017-0146-y · Cited by 12 · cited 1× · see citing works
“The wireless motility capsule may be used in ambulatory settings; it has the advantage of avoiding exposure to radiations, but its use is limited in dysphagia or possible bowel obstruction, due to its size [26].”
BackgroundThe Gut: A Key to the Pathogenesis of Type 2 Diabetes?
Holst, J., Pedersen, J., Albrechtsen, N. J. W., & Knop, F. (2017) · Metabolic Syndrome and Related Disorders · doi:10.1089/met.2017.0015 · Cited by 11 · see citing works
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“In contrast with whole-structure proteins, intragastric administration of isolated amino acids such as lysine, leucine, or isoleucine does not seem to influence gastric emptying, even though it may reduce postprandial glycemic levels, most probably by direct stimulation of insulin secretion [69, 70].”
BackgroundRationale for treatment options for mealtime glucose control in patients with type 2 diabetes
Aronoff, S. L. (2017) · Postgraduate Medicine · doi:10.1080/00325481.2017.1285191 · Cited by 11 · cited 2× · see citing works
“Several research teams found a direct relationship between the rate of gastric emptying and postprandial serum glucose levels [6, 7, 48, 49].”
BackgroundTrahair, L., Marathe, C., Standfield, S., Rayner, C., Feinle-Bisset, C., Horowitz, M., & Jones, K. (2017) · International Journal of Obesity · doi:10.1038/ijo.2016.202 · Cited by 7 · see citing works
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“Novel therapeutic guidelines for type 2 diabetes recommend the association of prandial GLP-1 receptor agonists to basal insulin; benefits of such pharmacologic combinations bring together the predominant effect of basal insulin on fasting glycemia and the effect of prandial GLP-1 receptor agonists on postprandial glyc…”
BackgroundImpact of Gastrointestinal Function on Glycaemic Control
Macdonald, I., Nauck, M., & Kong, M.-F. (2005) · doi:10.1002/0470013877.ch8 · Cited by 1 · cited 1×
“Most authors found that gastric emptying is increased even after recurrent episodes of hypoglycemia, not only in healthy individuals [24] but also in diabetic patients [50].”
Background
Flagged first, then by citations
8 of the 93 references couldn’t be matched to a known paper.
Research works printed but not linked: 4
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Cited by
Sorted by citations
Susceptibility for Some Infectious Diseases in Patients With Diabetes: The Key Role of Glycemia
Chávez‐Reyes, J., Escárcega‐González, C. E., Chavira-Suárez, E., León‐Buitimea, A., Vázquez-León, P., Morones‐Ramírez, J. R., Villalón, C. M., Quintanar‐Stephano, A., & Marichal‐Cancino, B. A. (2021) · Frontiers in Public Health · doi:10.3389/fpubh.2021.559595 · Cited by 194 · see citing works
Nutritional strategies to attenuate postprandial glycemic response
Pasmans, K., Meex, R. C. R., van Loon, L. J. C., & Blaak, E. E. (2022) · Obesity Reviews · doi:10.1111/obr.13486 · Cited by 71 · see citing works
“gastric emptying is inhibited by hyperglycemia and stimulated by hypoglycemia.(60) In healthy participants, mean gastric emptying time after a meal was found to be approximately 3.”
BackgroundRapid gastric emptying in diabetes mellitus: Pathophysiology and clinical importance
Goyal, R., Cristofaro, V., & Sullivan, M. (2019) · Journal of diabetes and its complications · doi:10.1016/j.jdiacomp.2019.107414 · Cited by 56 · see citing works
Novel insights into the pathogenic impact of diabetes on the gastrointestinal tract
Portincasa, P., Bonfrate, L., Wang, D. Q., Frühbeck, G., Garruti, G., & Ciaula, A. D. (2022) · European Journal of Clinical Investigation · doi:10.1111/eci.13846 · Cited by 37 · see citing works
Smith, K. A., Pugh, J. N., Duca, F. A., Close, G. L., & Ormsbee, M. J. (2021) · European Journal of Applied Physiology · doi:10.1007/s00421-021-04737-x · Cited by 41 · see citing works
Manipulation of Post-Prandial Hyperglycaemia in Type 2 Diabetes: An Update for Practitioners
Shibib, L., Al-Qaisi, M., Guess, N. D., Miras, A. D., Greenwald, S. E., Pelling, M., & Ahmed, A. (2024) · Diabetes Metabolic Syndrome and Obesity · doi:10.2147/dmso.s458894 · Cited by 39 · see citing works
“60 It has been suggested that rapid gastric emptying may precede frank type 2 diabetes.”
BackgroundThe role of whey protein in postprandial glycaemic control
Stevenson, E., & Allerton, D. M. (2017) · Proceedings of The Nutrition Society · doi:10.1017/s0029665117002002 · Cited by 32 · see citing works
Li, X., Liu, L., Liang, X., Li, Y.-T., & Wang, D.-X. (2022) · International Journal of Surgery · doi:10.1016/j.ijsu.2021.106215 · Cited by 18 · see citing works
Gastaldelli, A., Gaggini, M., & DeFronzo, R. A. (2017) · Current Opinion in Clinical Nutrition & Metabolic Care · doi:10.1097/mco.0000000000000384 · Cited by 19 · see citing works
O'Rielly, R., Li, H., Lim, S.-M., Yazbeck, R., Kritas, S., Ullrich, S. S., Feinle-Bisset, C., Heilbronn, L., & Page, A. (2020) · Nutrients · doi:10.3390/nu12082446 · Cited by 17 · see citing works
“Slowing gastric emptying allows for efficient digestion and absorption of nutrients, including glucose [13,36,37].”
BackgroundLappi, J., Raninen, K., Väkeväinen, K., Kårlund, A., Törrönen, R., & Kolehmainen, M. (2020) · British Journal of Nutrition · doi:10.1017/s0007114520004468 · Cited by 15 · see citing works
“Fat in the ingested meal is known to slow down the rate of gastric emptying(44,45), thus delaying the delivery of carbohydrates to the small intestine for digestion and absorption.”
BackgroundFano, M. D., Porcellati, F., Fanelli, C. G., Corio, S., Mazzieri, A., Lucidi, P., Bolli, G. B., & Bassotti, G. (2023) · Diabetes Research and Clinical Practice · doi:10.1016/j.diabres.2023.110828 · Cited by 13 · see citing works
von Gerichten, J., Elnesr, M. H., Prollins, J. E., Mel, I. D., Flanagan, A., Johnston, J., Fielding, B., & Short, M. (2022) · Lipids · doi:10.1002/lipd.12352 · Cited by 11 · see citing works
“As reviewed elsewhere, small differences in GE can have a major impact on postprandial glycaemia in health and type 2 diabetes (Mihai et al., 2018).”
BackgroundCasella-Mariolo, J. R., Castagneto‐Gissey, L., Angelini, G., Zoli, A., Marini, P., Bornstein, S. R., Pournaras, D. J., Rubino, F., le Roux, C. W., Mingrone, G., et al. (2019) · EBioMedicine · doi:10.1016/j.ebiom.2019.07.069 · Cited by 15 · see citing works
“As well as improving β-cell glucose sensitivity, both GLP1 and GLP1 receptor agonists (GLP1-RA) slow gastric emptying [40].”
BackgroundEsophageal and Gastric Motility Disorders in the Elderly.
Sendzischew-Shane, M. S., & Moshiree, B. (2021) · Clinics in Geriatric Medicine · doi:10.1016/j.cger.2020.08.002 · Cited by 7 · see citing works
Degeeter, T., Demey, B., Caelenberg, E. V., Baerdemaeker, L. D., & Coppens, M. (2021) · Acta Chirurgica Belgica · doi:10.1080/00015458.2021.1940438 · Cited by 6
“Solid foods are cleared in two phases; mixing of gastric fluids with solid foods (20-60min) followed by gastric emptying (zero-order kinetic) [12,13,29].”
BackgroundRasmussen, V. F., Thrysøe, M., Karlsson, P., Vestergaard, E. T., Kristensen, K., Christensen, A.-M. R., Nyengaard, J. R., Terkelsen, A. J., Brock, C., & Krogh, K. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12051925 · Cited by 5 · see citing works
“Likewise, improving gastric emptying time in patients with gastroparesis can potentially improve glycemic control [34].”
BackgroundTang, W.-Y., Hou, Y., Bai, C., & Shang, Y. (2025) · European Journal of Medical Research · doi:10.1186/s40001-025-02710-4 · Cited by 4
“High blood glucose also increases risk of aspiration pneumonia by delaying gastric emptying and decreasing gag reflexes [69].”
Abas, A., Sherif, M. H., & Ibrahim, S. (2025) · Advances in Biology · doi:10.1002/adbi.202400688 · Cited by 4
Çalışır, F., & Öksüz, G. (2025) · Journal of Maternal-Fetal & Neonatal Medicine · doi:10.1080/14767058.2025.2508267 · Cited by 3
“Mihai et al. reported that hyperglycemia delays gastric emptying as a protective mechanism to limit glucose entry into the small intestine and reduce postprandial glycemic fluctuations [25].”
Lou, X., Fan, Z.-H., Wei, J., Peng, X., Hu, J., Lu, X., & Liu, A. (2024) · Nutrients · doi:10.3390/nu16040535 · Cited by 3 · see citing works
“Although lipids evacuate more slowly from the stomach than carbohydrates or proteins do because of their high caloric content [41], the 9.5 g dose of nut in our trial might have been too low to affect the pace of stomach evacuation.”
BackgroundInfluentialIl ruolo dello svuotamento gastrico nell’omeostasi e nella controregolazione glucidica
Scientifica, D., Squatrito, S., Direttore, C., & Melloni, R. S. (2024) · il Diabete · doi:10.30682/ildia2304b
68Ga-NOTA PET imaging for gastric emptying assessment in mice
Chen, X., Liu, Y., Pan, D., Cao, M.-Y., Wang, X.-Y., Wang, L.-Z., Xu, Y.-P., Wang, Y., Yan, J.-J., Liu, J., et al. (2021) · BMC Gastroenterology · doi:10.1186/s12876-021-01642-7 · Cited by 3 · see citing works
“Since gastrointestinal motility disorders cannot be distinguished from inflammation or malignant diseases based on symptoms and medical history, and abnormal GE can influence and be influenced by many disease processes [42, 43], this established PET method for GE measurement would be promising to satisfy research need.”
BackgroundModifiable Factors Affecting the Postprandial Glycemic Response
Wu, Y., McLaughlin, T., Gorgani, S., Scheideman, A. F., Shao, M. M., Hislop, B. D., Hoang, K., Perelman, D., McGinity, C., Rodgar, M., et al. (2026) · Journal of Diabetes Science and Technology · doi:10.1177/19322968261418614 · Cited by 1 · see citing works
“22,23 Slower GE delays nutrient delivery into the intestine, resulting in blunted PPGRs, while faster GE increases PPGRs. 24,25 On the contrary, acute hyperglycemia slows GE, and acute hypoglycemia accelerates GE.”
Bortolotti, M. (2025) · World Journal of Gastroenterology · doi:10.3748/wjg.v31.i23.104932 · Cited by 2 · see citing works
“In fact, some studies have found that hyperglycemia tends to delay GE[32,33], whereas hypoglycemia accelerates it [34].”
Aydın, B. S., & Güldoğan, I. K. (2024) · Saudi Journal of Anaesthesia · doi:10.4103/sja.sja_339_23 · Cited by 2 · see citing works
“[15] Russo et al .”
Machado, M. P. R., Gama, L. A., Beckmann, A. P. S., Pinto, L. A., de Miranda, J. R. D. A., Marques, R. G., & Américo, M. (2023) · Neurogastroenterology and Motility · doi:10.1111/nmo.14717 · Cited by 2 · see citing works
A Meta-Analysis of the Efficacy of Prokinetic Agents against Glycemic Control
Kim, Y., Chung, W., & Lee, S. J. (2019) · Gastroenterology Research and Practice · doi:10.1155/2019/3014973 · Cited by 2 · see citing works
“The relationship between gastric emptying and plasma glucose control is bidirectional, which involves nutrient absorption and hormonal effect [23].”
BackgroundAmani, E., Yazdi, A. P. G., Bazsefidpar, N., Rahmati, M., Karimi, A., Assadpour, E., Barzegar, M., & Jafari, S. (2026) · Food Bioscience · doi:10.1016/j.fbio.2026.108454 · Cited by 1 · see citing works
Unmasking Gastroparesis in Diabetes During Ramadan: Challenges and Management Strategies
Abdulrasak, M., Shaat, N., Someili, A., & Mohrag, M. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14061997 · Cited by 1 · see citing works
“As previously mentioned, hyperglycemia slows GE and hypoglycemia accelerates GE, while slowed GE causes hypoglycemia and accelerated gastric emptying causes hyper-glycemia [57,58].”
Rapid gastric emptying during pregnancy in a rat model.
Salman, U. A., McMahan, C., Schwartz, J. G., Michalek, J., & Phillips, W. T. (2023) · European Journal of Obstetrics, Gynecology, and Reproductive Biology · doi:10.1016/j.ejogrb.2023.08.370 · Cited by 1 · see citing works
Diabetic gastroparesis: pathophysiology and impact on insulin timing choices
Galeano, F., Tumminia, A., Oteri, V., Le Moli, R., Piticchio, T., Scilletta, S., Di Marco, M., Di Pino, A., & Frasca, F. (2026) · Endocrine · doi:10.1007/s12020-026-04693-6
Functional soups as food matrices for bioactive compounds: Implications for cognitive health
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“2018) which by implication slows down absorption (Mihai et al. 2018)”
BackgroundLi, X., Liu, L., Liang, X., Li, Y.-T., & Wang, D.-X. (2020) · doi:10.21203/rs.3.rs-62176/v1
The Role of High Sugar Diets in Colitis
Rajaruban, S. (2020) · ERA: Education and Research Archive (University of Alberta) · doi:10.7939/r3-tthe-t208
- Authors
- Mihai, B. M., Mihai, C., Cijevschi-Prelipcean, C., Grigorescu, E.-D., Dranga, M., Drug, V., Sporea, I., & Lăcătușu, C. M.
- Affiliations
- Grigore T. Popa University of Medicine and Pharmacy (RO)
- “Grigore T. Popa” University of Medicine and Pharmacy, Institute of Gastroenterology and Hepatology, “Sf. Spiridon” Clinical Hospital, Iași, Romania
- Victor Babeș University of Medicine and Pharmacy Timișoara (RO)
- Corresponding author
- Mihai, Cătălina
- ORCID
- Venue
- Journal of Diabetes Research
- Publisher
- Wiley
- Published
- 2018-10-03
- Volume
- 2018
- Pages
- 1-9
- ISSN
- 2314-6745 (ISSN-L)
- 2314-6753
- PMC
- PMC6192082
- OpenAlex
- W2895661608
- Cited by
- 46
- References
- 93
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 4 · 2023: 4 · 2022: 7 · 2021: 9 · 2020: 6 · 2019: 4 · 2017: 1
- FWCI
- 0.85
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Journal of Diabetes Research (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- gastric emptying, glycemic control, diabetes mellitus, glucagon-like peptide-1, incretins, postprandial hyperglycemia, glycemic variability, hypoglycemia, hyperglycemia, GLP-1 receptor agonists, meal structure, dietary change
- MeSH terms
- Blood Glucose, Diabetes Mellitus, Type 2, Gastric Emptying, Glucagon, Humans, Insulin, Postprandial Period, Glucagon-Like Peptide 1
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